The Patient-Centered Medical Home (PCMH) is currently seen by many policy-makers, payers, purchasers, and primary care leaders as one of the most important vehicles for accomplishing the Triple Aim (improving health, patient experience, and cost) while saving primary care from its current deterioration. We propose to work closely with the Minnesota state agencies responsible for a legislative initiative to transform traditional primary care clinics throughout the state to PCMHs. We will first test whether clinics that have demonstrated large increases in the practice systems associated with the PCMH also have large increases in quality of care measures for diabetes and cardiovascular disease patients, using existing standardized data. This information will help us to create groups of clinics to compare with transformed clinics in healthcare costs and utilization, patient satisfaction, and clinician/staff satisfaction. Simultaneously, we will interview personnel in ten of the transformed clinics in order to learn how they achieved this, utilizing a conceptual framework that includes information about their change priority, change capability and process, care content changes, and contextual features (internal and external) that seem associated with their successful change. This information will then be incorporated in a survey of personnel in both transformed and standard clinics so that we can identify the characteristics and strategies that differentiate those with successful change. Finally, we will work with our partner public and private organizations in Minnesota to use this information to help all state primary care clinics to transform and with national partners to disseminate the lessons widely. We have many unique advantages for conducting this type of study, especially a great partnership with the current large statewide initiative to facilitate this transformation. Other advantages include an existing public reporting system that will provide us with standardized clinic-level quality and satisfaction measures and payers that will provide us with cost and utilization data for patients at specific clinics. In addition, we have substantial expertise in primary care transformation studies, including a long-term working relationship with NCQA in the development and testing of the instrument being used to certify clinics as PCMHs nationally. Finally, we also have unique relationships that will allow us to facilitate widespread awareness and use of the lessons that we learn from this study. PUBLIC HEALTH RELEVANCE: Strong primary care systems have been demonstrated in many studies and countries to be strongly correlated with good health. The Minnesota legislature has required a new payment system for primary care clinics that provide advanced patient-centered services through transformation to health care homes for their patients. This study will work with the state agencies leading this conversion to learn how to help clinics make this transformation and whether doing so improves patient quality, experience, and costs. Then we will facilitate widespread awareness and use of what we learn to support similar clinic transformations.